Day J D, Fukushima T
Allegheny Neuroscience Institute, Allegheny University for the Health Sciences, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
Neurosurgery. 1998 Feb;42(2):233-40; discussion 240-1. doi: 10.1097/00006123-199802000-00015.
Trigeminal neuromas are rare tumors that may involve any part of the nerve complex, including peripheral divisions of the nerve. These rare lesions are treated primarily surgically. We present our series of 38 patients who were treated surgically since 1981, with special emphasis on surgical approach.
We have surgically treated 38 patients with 39 trigeminal neuromas since 1981. This series of patients was reviewed with regard to clinical presentation, tumor characteristics, surgical approach, and outcome.
Sixteen women and 22 men (mean age, 48 yr) all presented with some abnormality of trigeminal dysfunction. Twenty-eight patients presented with trigeminal hypesthesia, 10 with hypesthesia also had facial pain, 3 presented with only facial pain, and 7 presented with diplopia. Eighteen patients had tumors originating from the ganglion, nine from the posterior fossa nerve root, two from the ophthalmic division, and one from the mandibular division, and nine had tumors involving both posterior and middle fossae (dumbbell type). Eighteen tumors were large (>3 cm), 16 were medium sized (2-3 cm), and 5 were small (<2 cm). Tumor location was the prime determinant of surgical approach. Patients with peripheral and ganglion type lesions were treated via an entirely extradural temporopolar approach. Lesions confined to the posterior fossa were approached via a lateral suboccipital approach. Dumbbell-shaped lesions required a combined petrosal strategy. Total resection of tumor was accomplished in 30 patients. Three patients with subtotal resection displayed malignant histology. Postoperatively, 30 patients remained with some degree of trigeminal hypesthesia, two had facial pain (one persistent and one new), and five were left with total trigeminal anesthesia. Four patients were relieved of diplopia, five were relieved of headache, and two were relieved of ataxia. There were no perioperative deaths.
Trigeminal neuroma is a surgically treatable disease that may be operated on, in many cases, via an entirely extradural approach. These lesions may be successfully resected with low morbidity and a very low rate of recurrence.
三叉神经瘤是一种罕见肿瘤，可累及神经复合体的任何部位，包括神经的外周分支。这些罕见病变主要通过手术治疗。我们展示自1981年以来接受手术治疗的38例患者系列，特别强调手术入路。
自1981年以来，我们对39例三叉神经瘤患者进行了手术治疗。对该系列患者的临床表现、肿瘤特征、手术入路和结果进行了回顾。
16名女性和22名男性（平均年龄48岁）均表现出三叉神经功能障碍的某种异常。28例患者出现三叉神经感觉减退，其中10例感觉减退的患者也有面部疼痛，3例仅表现为面部疼痛，7例表现为复视。18例患者的肿瘤起源于神经节，9例起源于后颅窝神经根，2例起源于眼支，1例起源于下颌支，9例患者肿瘤累及后颅窝和中颅窝（哑铃型）。18个肿瘤较大（>3 cm），16个为中等大小（2 - 3 cm），5个为小肿瘤（<2 cm）。肿瘤位置是手术入路的主要决定因素。外周型和神经节型病变患者通过完全硬膜外颞极入路治疗。局限于后颅窝的病变通过枕下外侧入路治疗。哑铃形病变需要联合岩骨策略。30例患者实现了肿瘤全切。3例次全切除患者显示为恶性组织学。术后，30例患者仍有一定程度的三叉神经感觉减退，2例有面部疼痛（1例持续存在，1例新发），5例出现完全性三叉神经麻醉。4例患者复视缓解，5例患者头痛缓解，2例患者共济失调缓解。无围手术期死亡。
三叉神经瘤是一种可通过手术治疗的疾病，在许多情况下可通过完全硬膜外入路进行手术。这些病变可成功切除，发病率低，复发率极低。
